NPIMap

Organization Active NPI

Richard Intiso D.M.D., PA

  • General Practice Dentistry
  • Windham, ME
National Provider Identifier
1417074733
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DENTAL 3564 Issued in ME
Legal business name
RICHARD INTISO D.M.D., PA
Doing business as
D.B.A. Windham Dental Associates
Practice address
4 Commons Ave Ste 2
Windham, ME 04062-5554
Phone
(207) 893-2001
Fax
(207) 893-2006
NPI assigned
Mar 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Richard M Intiso, DMDNPI 1659330157
Title
Dentist
Phone
(207) 893-2001

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DENTAL 3564 ME Primary

Addresses

Primary practice location

4 Commons Ave Ste 2
Windham, ME 04062-5554

Mailing address

4 Commons Ave Ste 2
Windham, ME 04062-5554
Phone (207) 893-2001

Other names 1

  • D.B.A. Windham Dental Associates Doing business as

National Provider Directory

National Provider Directory

Locations

4 Commons Ave
Ste 2
Windham, ME 04062
Phone (207) 893-2001

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417074733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 COMMONS AVE STE 2",
            "city": "WINDHAM",
            "state": "ME",
            "postal_code": "040625554",
            "telephone_number": "207-893-2001",
            "fax_number": "207-893-2006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 COMMONS AVE STE 2",
            "city": "WINDHAM",
            "state": "ME",
            "postal_code": "040625554",
            "telephone_number": "207-893-2001",
            "fax_number": "207-893-2006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHARD INTISO D.M.D., PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "INTISO",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "207-893-2001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ME",
            "license": "DENTAL 3564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "D.B.A. Windham Dental Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Windham, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.